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目的总结儿童黑热病的临床特点、诊治方法及转归情况。方法总结10例黑热病患儿的临床资料,回顾性分析其流行病学特点、临床表现、实验室检查结果、治疗及转归情况。结果 10例患儿中男3例,女7例;中位年龄1.63岁。9例来自黑热病高发地区,5例家中有狗喂养史。10例均以不明原因发热就诊,院外发热时间7 d～1个月。9例面色苍白,5例营养不良。10例均有肝脾大,其中2例为巨脾,2例有少量腹腔积液。8例合并呼吸道和消化道感染。10例血细胞减少,7例肝酶升高,8例清蛋白减少,5例血脂异常,4例胆红素升高,3例凝血功能明显异常。血rK39免疫层析法检测10例患儿均阳性,且骨髓增生活跃,其中9例骨髓涂片检出利什曼原虫。予葡萄糖酸锑钠治疗3～6 d,9例体温恢复正常,1例0.5 a后复发,再次予葡萄糖酸锑钠治疗有效。住院期间肝脾回缩不明显,无死亡病例。结论对反复高热,伴有肝脾大及血细胞减少,尤其来自黑热病高发地区的患儿,在普通抗感染治疗无效的情况下,应高度怀疑黑热病,rK39免疫学及骨髓穿刺检查能明确诊断,予葡萄糖酸锑钠治疗有效。
Objective To summarize the clinical features, diagnosis and treatment of children with kala azar and prognosis. Methods The clinical data of 10 children with kala-azar were summarized and their epidemiological characteristics, clinical manifestations, laboratory findings, treatment and prognosis were retrospectively analyzed. Results Among the 10 children, 3 were male and 7 were female, with a median age of 1.63 years. Nine cases were from high incidence of kala-azar and five cases had history of dog feeding. 10 cases were fever for unknown reasons, hospital fever time 7 d ~ 1 month. 9 cases pale, 5 cases of malnutrition. 10 cases were hepatosplenomegaly, including 2 cases of splenomegaly, 2 cases had a small amount of ascites. 8 cases with respiratory and gastrointestinal infections. 10 cases of cytopenia, 7 cases of liver enzymes increased, 8 cases of albumin decreased, 5 cases of dyslipidemia, 4 cases of bilirubin, coagulation abnormalities in 3 cases. Blood rK39 immunochromatography test in 10 cases were positive, and bone marrow hyperplasia, of which 9 cases of bone marrow smear Leishmania. Antimony gluconate treatment for 3 ~ 6 d, 9 cases of body temperature returned to normal, 1 case of 0.5 a relapse, again to antimony gluconate treatment. Liver and spleen retraction during hospitalization was not obvious, no deaths. Conclusions Children with recurrent fever, hepatosplex and splenomegaly and cytopenia, especially from areas with high incidence of kala-azar, should be highly suspected of kala-azar in the case of general anti-infective therapy. The rK39 immunology and bone marrow biopsy can confirm the diagnosis, Antimony gluconate treatment effective.